Outline

Objective

The dens fracture is the most frequent fracture of the cervical spine in the geriatric patient. In old people, the management of this kind of fracture is more complicated due to associated diseases and biomechanical changes of the aging spine. The aim of this study was to compare clinical data and treatment options of patients with dens fractures over 65 years to controls younger than 65 years.

Methods

A retrospective study of 49 patients with all types of dens fractures, who were consecutively admitted to our institution between 1992 and 2003, was performed. Demographic data, type of trauma, Frankel grade, ASA score, type of fracture according to Anderson and d’ Alonzo, dens displacement, associated atlas fractures, surgical and non-surgical procedures were analysed and separated in the geriatric (>65 years) and the young (<65 years) group. Follow-up including clinical investigation and cervical x-rays were done.

Results

The complete series revealed seventeen patients older than 65 years (8 female, mean age 78, range 65-98 years). Falling was the cause of fracture in 76 % of the elderly opposite 19 % of the young. All patients, except 7 in the group < 65 years, were Frankel grade E. The geriatric group exposed 8 type II and 9 type III fractures. In contrast 75% of the young patients revealed type II fractures. 30% of all patients had a dens displacement and 17% an associated atlas fracture. Six out of 17 patients > 65 years were treated conservatively. Twenty two patients < 65 years were treated surgically. Follow-up was done in 32 patients (8 vs 24), mean 12,4 months. Stable fusion was seen in 24 patients. In the elderly we found two non-unions during follow-up. One was a Type II fracture after anterior screw fixation and the other a Type III treated with a Minerva brace. In the young we have seen six non-unions, two halo device treated type II fractures, two type II and type III fractures after surgical treatment.

Conclusions

There was no higher rate of non-unions in the geriatric than in the younger patients in our series during follow-up. In our experience an increasing risk of morbidity or mortality did not depend on surgical or non-surgical treatment in the elderly.